Impacts on health-related quality of life after prostate cancer treatment among a Finnish prostate cancer screening population

HISASUE, TOMOMI (2011)

Hyväksymispäivämäärä

Tiivistelmä

Background

The measurement of health-related quality of life (HRQoL) has become an important health outcome among prostate cancer patients. Prostate-specific antigen (PSA) screening can be effective at detecting prostate cancer at an early stage. However, the screening can be associated with overdetection and overtreatment, resulting in a decreased HRQoL among patients. Since health care resources are limited, assessing HRQoL is crucially important to evaluate the acceptability of PSA screening. The main purpose of this thesis was to investigate the association between the treatment-related adverse effects of prostate cancer and HRQoL by using the generic HRQoL instrument, the 15D, in a Finnish randomised population-based prostate cancer screening trail.

Patients and methods

Data was collected from men with prostate cancer in the Finnish section of the European Randomized Study of Screening for Prostate Cancer (ERSPC). In the Finnish screening trial, approximately 20,000 men aged 55, 59, 63 and 67 from Helsinki and Tampere regions were randomly allocated to the screening arm, the remaining was treated as controls. From the period between May 1996 and Dec 2002, a total of 1667 men with newly diagnosed prostate cancer from the screening population were identified. Of these, 1417 men with prostate cancer who completed questionnaires were included in this study. The validated generic HRQoL measure, the 15D was used to measure HRQoL and the study focused both on overall HRQoL and three dimensions of the 15D (sleeping, elimination and sexual activity). Treatment-related side effects (urinary, sexual, bowel and hormone dimensions) were measured based on patient self-reports.

Results

Both HRQoL and the prevalence of side effects were not statistically significantly different between screening and control groups whereas treatment choices between the two groups were statistically significantly different. The mean scores of sleeping and sexual dimensions of the 15D and the mean 15D scores of the screening population were statistically significantly lower in comparison with reference population. Treatment choices were associated with the prevalence of prostate-specific side effects, the sexual dimension of the 15D and overall HRQoL. Sex-related symptoms were the most common side effects and higher occurrence was observed in surgery patients. The presence of erectile side effects was associated with the sexual dimension of the 15D and overall HRQoL. However, other side effects were not found to be related to the three dimensions (sleeping, elimination and sexual activity) of the 15D or overall HRQoL. After adjusting for a number of factors, patients who experienced the worst sexual health state of the 15D were highly likely to have more comorbidites, the presence of diabetes and to be married. The impact of active treatment was more related to the second worst sexual health state of the 15D.

Conclusions

Sexual dysfunction caused by treatment negatively impacted both the sexual dimension of HRQoL and overall HRQoL. The use of the 15D facilitated to measure overall HRQoL which covered prostate specific dimensions among prostate cancer patients. Since prostate cancer is common in elderly populations, more efforts are needed to accurately measure treatment-related side effects as well as their general health conditions. The findings from this study can be useful when assessing the negative effects of screening in terms of HRQoL and costs.